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目的以根治性前列腺切除术作为参考标准,回顾性比较3TT2W成像与多参数MR成像对前列腺移行区癌检测和定位的准确性。材料与方法机构审查委员会免除了本研究知情同意书。纳入标准为:经根治性前列腺切除术移行区癌>0.5cm3且术前行3T直肠内多参数MR成像的病人[T2WI,DWI表观扩散系数(ADC,b<1000s/mm2)图,动态对比增强成像(DCE)]。共197例病人接受了根治性前列腺切除术,其中28例为前列腺移行区癌入组。35例未发现前列腺移行区癌的病人被随机选出作为对照组。4名放射科医生随机对T2WI和DWADC图,T2WI和DCEMRI,T2WI、DWADC图和DCEMRI进行评分。对可疑为移行区癌的区域测量6个感兴趣区(ROI),按照5点评分法进行评分。评为4～5分为阳性发现;移行区癌任何一个感兴趣区评分为4分或更高,认为该病人水平具有阳性发现。使用广义估计方程来分析病灶的检出和定位的准确性,使用受试者操作特征(ROC)曲线来分析定位的准确性。对Gleason分级(GG)为4～5和2～3的癌症病人进行独立分析。结果 T2WI影像与多参数MR成像对所有移行区癌检测的准确度没有明显差异(68%和66%,P=0.85),GG4～5级的移行区癌分别为79%和72%～75%(P=0.13),GG2～3级的移行区癌分别为66%和62%～65%(P=0.47)。多参数MR成像[ROC曲线下面积(AUC),0.70～0.77]并没有明显提高T2WI定位的准确性(AUC=0.72,P<0.05)。结论使用多参数3TMR成像,包含T2WI、DWIADC图(b值为50、500、800s/mm2)及DCEMRI与T2WI比较并没有显著提高移行区癌检测和定位的准确性。
Objective To compare the accuracy of 3TT2W imaging and multi-parametric MR imaging in detecting and locating prostate cancer in prostatectomy using radical prostatectomy as a reference standard. Materials and Methods The institutional review board removed the research informed consent. The inclusion criteria were: T2WI, apparent diffusion coefficient of DWI (ADC, b <1000s / mm2) in patients undergoing radical prostatectomy for cancers> 0.5cm3 and preoperative 3T intrarectal multi-parameter MR imaging, dynamic contrast Enhanced Imaging (DCE)]. A total of 197 patients underwent radical prostatectomy, of which 28 cases of prostate transitional cancer into the group. Thirty-five patients without prostate cancer were randomly selected as the control group. Four radiologists randomly scored T2WI and DWADC maps, T2WI and DCEMRI, T2WI, DWADC maps, and DCEMRI. Six regions of interest (ROI) were measured in areas suspected of being transitional area cancers and scored on a 5 point scale. Rated as 4 to 5 points for positive findings; transitional zone cancer of any one area of interest score of 4 points or higher, that the patient’s level with a positive finding. Generalized estimation equations were used to analyze the accuracy of lesion detection and localization, and receiver operating characteristic (ROC) curves were used to analyze the accuracy of localization. Cancer patients with Gleason grading (GG) of 4 to 5 and 2 to 3 were independently analyzed. Results There was no significant difference (68% vs 66%, P = 0.85) in the accuracy of T2WI imaging and multi-parameter MR imaging in all transitional zone cancers. The rates of GG grade 4-5 transitional carcinoma were 79% and 72% -75% (P = 0.13). The incidence of GG2 ~ 3 grade transitional carcinoma was 66% and 62% ~ 65% respectively (P = 0.47). Multi-parameter MR imaging [area under the curve of ROC (AUC), 0.70-0.77] did not significantly improve the accuracy of T2WI localization (AUC = 0.72, P <0.05). Conclusions The use of multi-parameter 3T MR imaging, including T2WI and DWIADC maps (b values of 50, 500, 800s / mm2) and DCEMRI compared with T2WI did not significantly improve the accuracy of detection and localization of cancer in the transitional zone.